RESUMEN
Reperfusion injury is common following primary percutaneous coronary intervention (PCI) in ST-elevation myocardial infarction. In a prospective Canadian single-arm study of 15patients, the use of myocardial contrast echocardiography with high mechanical index ultrasound impulses (sonothrombolysis) initiated prior to primary PCI resulted in 7 patients with pre-PCI thrombolysis in myocardial infarction-2/3 flow (46.7%). Following reperfusion, all 15 patients had thrombolysis in myocardial infarction-3 flow, and 14 patients achieved ST-segment resolution ≥ 50% at 30 minutes post-PCI (93.3%). At 90 days, 12 patients had normal left ventricular ejection fraction ≥ 50% (80.0%). Our results demonstrate the feasibility of a novel technique to enhance reperfusion in ST-elevation myocardial infarction and provide a rationale for a randomized Canadian study.
La lésion de reperfusion est fréquente après l'intervention coronarienne percutanée (ICP) primaire chez les patients atteints d'un infarctus du myocarde avec élévation du segment ST. Dans une étude prospective canadienne, à volet unique, auprès de 15 patients, l'utilisation de l'échocardiographie myocardique de contraste par des impulsions ultrasonores à indice mécanique élevé (sonothrombolyse) amorcée avant l'ICP primaire s'est traduite par sept patients qui ont eu une thrombolyse pré-ICP de l'infarctus du myocarde de flux de grade 2/3 (46,7 %). Après la reperfusion, les 15 patients ont subi une thrombolyse de l'infarctus du myocarde de flux de grade 3, et 14 patients ont eu une résolution du segment ST ≥ 50 % 30 minutes après l'ICP (93,3 %). Après 90 jours, 12 patients ont eu une fraction d'éjection ventriculaire gauche normale ≥ 50 % (80,0 %). Nos résultats démontrent la faisabilité d'une nouvelle technique pour améliorer la reperfusion des infarctus du myocarde avec élévation du segment ST et justifient la réalisation d'une étude canadienne à répartition aléatoire.
RESUMEN
A recent study found that rates of hospitalization for syncope vary across provinces; however, it is unknown whether differences in comorbidity burden and outcomes also exist. The Canadian Institute for Health Information Discharge Abstract Database was used to identify primary syncope hospitalizations (ICD-10 code R55) from 2004 to 2013 for all provinces (except Quebec). Charlson comorbidity score was calculated from comorbidities at the time of hospitalization. Outcomes were defined as in-hospital mortality, 30-day readmission for any cause, and syncope. Logistic regression models were constructed for odds ratios (ORs) and 95% confidence intervals (CIs) to estimate interprovincial differences in outcomes. The interprovincial range (IPR) for mean age was 61.1 ± 17.5 to 73.7 ± 16.3 years, and at least half were male patients. There were significant differences in comorbidity burden across provinces (P < 0.01); however, the majority of patients had a Charlson comorbidity score = 0 (IPR, 53.9%- 71.9%). In multivariable analysis, compared with Ontario, in-hospital mortality was higher for British Columbia (OR, 1.59; 95% CI, 1.22-2.06), Nova Scotia (OR, 1.67; 95% CI, 1.05-2.65), and Newfoundland (OR, 2.27; 95% CI, 1.29-4.00); 30-day readmission for any cause was higher for British Columbia (OR, 1.15; 95% CI, 1.06-1.26), Alberta (OR, 1.19; 95% CI, 1.07-1.31), Manitoba (OR, 1.36; 95% CI, 1.18-1.56), and Prince Edward Island (OR, 1.38; 95% CI, 1.0-1.89), and all outcomes were higher in Saskatchewan. There is significant interprovincial heterogeneity in comorbidity burden and outcomes for hospitalizations for syncope. Future research evaluating whether standardized practices for management of syncope reduce variability and improve healthcare utilization and costs is needed.
